Therapy with Adults with ADHD: What Therapists Often Miss
In the last few years, many adults have been approaching therapy with questions about ADHD or with a formal diagnosis already in place. Yet adult psychotherapy often misses the lens of neurodivergence. For me, this understanding has felt personal and led to a deeper reflection on my own therapy practice.
Earlier in my career, I spent several years working with children and adolescents. During that time, I encountered many clients who had been identified with ADHD early in life. I had the opportunity to travel alongside them as they moved from childhood into young adulthood, watching the shape and presentation of ADHD change over time. But, as I took on the role of an adult therapist and shed my position as a child therapist, I noticed my therapy process shift too.
Adult psychotherapy, as commonly practiced, does not account for encounters with neurodivergence. The therapy approach that felt intuitive when working with children – use of creative tools, flexible structures, and collaborative scaffolding – quietly disappeared from my adult work. And the room and space I intentionally created for children gradually shrank into rigid boxes. Without noticing at first, I had begun expecting all my clients to fit into these structures.
Over time, this left me wondering whether it was not only clients who were struggling inside therapy, but therapy structures themselves that were struggling to accommodate neurodivergent ways of processing.
Adult psychotherapy assumes a kind of client who can hold insights between sessions, carry threads of conversations from one session to another, translate reflection into consistent action and sustain therapeutic meaning-making. Neurodivergence, when it appears in this space, is either not accounted for or is framed primarily as a disorder to be corrected.
A client may say they forgot the conversation from the previous session, missed doing a task discussed in therapy, or even forgot the appointment altogether. Another might come with a crisis in one session and completely shift to another topic in the next session.
When these expectations are not met, our clinical language quickly moves toward familiar explanations, depending on our leanings within psychotherapeutic tradition – resistance, avoidance, lack of motivation. Unlike work with children, where flexibility is often built into the process, such moments in adult therapy can quietly accumulate into frustration for therapists as well. As I began building a neurodiverse lens in my work with adults with ADHD, I started to realise that something else was often happening in these moments. The difficulty was not always some kind of psychological reluctance.
Sometimes the bridge between intention and action simply did not hold.
Over time, I noticed patterns emerging across sessions. A client would leave therapy feeling clear and hopeful, only to return the following week saying they could not remember what they had intended to try. Another would speak passionately about wanting change, yet feel paralysed when it came to beginning even the smallest step. Some described becoming intensely absorbed in particular kinds of tasks while everyday responsibilities quietly fell apart around them. Others spoke of emotional reactions that arrived quickly and intensely, leaving them confused about their own responses. Some started therapy with so much motivation and change but hit a slump within a few weeks. None of these moments fit neatly into the explanations I had been trained to reach for. Yet they were not rare occurrences either. They were patterns the neurodiverse lens accounted for.
What the neurodivergence lens offered to me was a way to view my clients differently from how a neurotypical world often sees them. In some ways, it felt like returning to the sensibility I carried as a child therapist, while still remaining grounded in the depth and complexity of adult psychotherapy.
It opened me to be curious about the therapy blocks and question the structures of therapy rather than the client alone. It created space to build therapeutic relationships that were not governed solely by the implicit rules of therapy, the expectations of society, or the internalised standards many clients carry after years of being told who they should be. I learned to anchor myself within it while still working through my preferred therapeutic model. Rather than replacing the foundations of my work, it expanded them.
Holding this perspective has slowly changed the kind of questions I ask within my therapy process:
Am I encouraging my clients to move closer to what the world expects of them or toward what genuinely allows them to live more meaningfully?
What might need to shift in the structure of my therapy process so that clients can experience change gradually, rather than being met too quickly with interpretation?
When I engage in skill-building, whose definitions am I drawing from – social expectations of productivity and punctuality or the client’s own vision of a life that feels possible and sustaining?
And perhaps most importantly: how might therapy itself adapt to meet the way a client’s mind prefers to view the world?
There are no easy answers to these questions, but they continue to shape my practice. Often, the shift they invite is subtle, but the impact in the therapy room and therapeutic relationship is rewarding.
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